实体器官移植受者侵袭性真菌病的临床治疗管理

随着实体器官移植（SOT）的广泛开展,SOT受者术后侵袭性真菌病（IFD）的发生率呈逐年上升趋势。近年来,对于SOT受者预防性抗真菌治疗意识不断增强,随之也出现了真菌耐药问题,导致原有标准化抗真菌治疗的效果不理想。而药物相互作用、药物的肝肾毒性等问题,也是临床医师需面对的挑战。本文综述了目前三唑类、棘白菌素类以及多烯类抗真菌药物与免疫抑制药之间的药物相互作用和肝肾毒性等特征,并总结了目前不同种类SOT受者术后IFD的预防策略以及感染不同病原体导致IFD的治疗策略,旨在为器官移植及相关学科的医师提供参考。     

Isavuconazonium sulfate: a new agent for the treatment of invasive aspergillosis and invasive mucormycosis

Introduction: Invasive fungal infections are serious and life-threatening complications of many of today’s medical enhancements. While we have seen an insurgence of new antifungal therapies on the market since the early 1990s that have contributed significantly to saving lives, there are still important gaps including narrow spectrum of activity, dose-limiting toxicities, or unpredictable pharmacokinetics. Isavuconazonium sulfate hopes to fill several of these gaps.

Areas covered: The in vitro and in vivo pharmacology, pharmacokinetic characteristics, and phase 3 clinical trials for isavuconazole are described with a specific focus on the treatment of invasive aspergillosis and mucormycosis. A literature search was conducted in PubMed as well as FDA and EMA websites, and abstracts from congress proceedings.

Expert Commentary: Isavuconazole’s pharmacokinetic profile, broad-spectrum antifungal activity, and clinical trial data make this new triazole a welcome addition to the armamentarium.     

Invasive Aspergillosis after Pandemic (H1N1) 2009

We report 2 patients with invasive aspergillosis after infection with pandemic (H1N1) 2009. Influenza viruses are known to cause immunologic defects and impair ciliary clearance. These defects, combined with high-dose corticosteroids prescribed during influenza-associated adult respiratory distress syndrome, may be novel risk factors predisposing otherwise immunocompetent patients to invasive aspergillosis.     

肺曲菌病的CT诊断

目的探讨肺曲菌病影像学方面的改变。方法经病理及临床证实的肺曲菌病患者9例,均行X线平片及CT常规扫描3例,2个月后X线CT复查。结果影像学表现为肿块样改变炎症样病变,粟粒样、肉芽肿或莽菌球,多发结节。其中5例CT出现“晕轮征”。结论肺曲菌病的早期影像学改变有肿块,多发结节,实变。CT影像学的“晕轮征”是肺曲菌病的特征性改变。CT可清晰显示特征性病变,可明确部位及范围,是该病的首选方法。     

Recommendations for the treatment of fungal pneumonias

Incidences of fungal pneumonias have increased in immunocompromised patients with HIV infection or receiving bone marrow replacement or solid organ transplantation. Fungal pneumonias including aspergillosis, cryptococcosis, candidiasis, coccidioidomycosis, histoplasmosis and blastomycosis are one of the major causes of morbidity and mortality among the immunosuppressed hosts. Therefore, clinicians should consider the most appropriate and aggressive treatment of fungal pneumonias in this population. This report outlines the state of the art in the treatment of fungal pneumonias and discusses recent advances in antifungal therapy. Practice guidelines for the treatment with commonly used antifungal agents including amphotericin B, fluconazole, itraconazole, ketoconazole and flucytosine, are very useful for clinicians to manage the diseases appropriately. Echinocandins and second-generation triazoles will hopefully help clinicians to overcome the limitations of the current therapy.     

The echinocandin micafungin: a review of the pharmacology,spectrum of activity,clinical efficacy and safety

Micafungin is a relatively broad-spectrum antifungal agent available for clinical use in the US and Japan. By inhibiting the production of β-1,3-glucan, an essential fungal cell wall component, micafungin has reduced toxicity to mammalian cells while maintaining potent antifungal activity against many pathogenic fungi including polyene- and azole-resistant isolates. Indeed, micafungin has been shown to be efficacious in the treatment of infections caused by Candida and Aspergillus species in clinical trials without the associated toxicities of amphotericin B formulations and drug interactions that occur with the azoles. In this review, the pharmacology, spectrum of activity, clinical efficacy and safety profile of micafungin are discussed.     

非中性粒细胞缺乏患者发生侵袭性曲霉病的危险因素、临床特征及预后分析

目的了解非中性粒细胞缺乏患者发生侵袭性曲霉病（invasive aspergillosis,IA）的危险因素、临床特征及预后。方法根据EORTC/MSG2002年制定的定义及我国侵袭性肺曲霉菌病的分级诊断标准,将郑州大学第一附属医院2001年1月至2006年12月诊断的54例侵袭性曲霉病分为：确诊8例,临床诊断31例,拟诊15例,进行回顾性分析。结果中性粒细胞缺乏组24例,其中20例为血液系统恶性肿瘤;非中性粒细胞缺乏组30例,主要是接受激素治疗的COPD患者（36.7%）。发热、胸闷、咳嗽、胸痛、咯血为常见症状。胸部CT显示节段性肺实变在中性粒细胞缺乏组多见,非中性粒细胞缺乏组则以多发结节阴影为主。结节或实变影内空洞形成较晕轮征、新月征更常见。IA总体病死率达72.2%,非中性粒细胞缺乏组高于中性粒细胞缺乏组（83.3%vs58.3%,P=0.042）。预后危险因素分析表明,肺外播散与预后有关。结论非中性粒细胞缺乏患者发生IA并非少见,接受激素治疗的COPD患者是发生IA的主要危险因素。前者病死率高于中性粒细胞缺乏患者。     

临床药师参与2例肺曲霉菌感染合理用药病例报道

本文报道临床药师参与2例肺曲霉菌感染合理应用抗真菌治疗方案制定,取得良好疗效,避免了药物不良反应。临床药师深入临床一线,提供药学服务有助于提高疗效,减少不良反应。